"HUH?" How 72% Of This Country's AIDs Medicare Claims Came From S.Florida In 2005!

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"HUH?" How 72% Of This Country's AIDs Medicare Claims Came From S.Florida In 2005!

"Of all the bills that Medicare/Medicaid received in 2005 for AIDS/HIV patients in the entire country, a whopping 72 percent came from Broward, Miami-Dade, and Palm Beach counties. Verrry strange — especially when you consider that only 8 percent of the nation's HIV/AIDS beneficiaries lived here in 2005. South Florida providers charged $2.5 billion to Medicare for HIV/AIDS treatments that year, which was more than twice the $978 million charged by the rest of the country combined.

What accounts for this disparity?

Apparently, it's driven by a money-making scheme that investigators now call the "infusion therapy scam." It goes like this: An average Joe applies for a Medicare provider number. There's no education requirement, and no medical background is needed, just a wallet big enough to carry away all the money you'll get. (Some of this is described in Deirdra Funcheon's New Times cover story "Rx for Plunder" from September 20, http://www.browardpalmbeach.com/2007...r-plunder/full ).

Providers then open infusion clinics where AIDS patients ostensibly come to get medicine administered intravenously. The patient pays nothing for the service; Medicare pays the clinic directly. And the payments come fast and plentifully. Medicare pays automatically, direct-depositing funds into providers' accounts within 16 days. "Any criminal with a few hours on his hands can figure out what gets paid," says a health-care fraud expert with a law enforcement background, who declined to be named. Clinic owners naturally bill for services with the greatest profit margins. "You could be a multimillionaire in 30 days," the expert says.

By looking at billing patterns, the Health and Human Services' Office of the Inspector General (OIG) saw instances where multiple clinics claimed to have given infusion treatments to the same patient on the same day. Sometimes, a clinic doled out cheap vitamins but billed for expensive drugs or a clinic billed for services on a day that it was supposedly closed. Sometimes patients got kickbacks for participating in one of the schemes (the going rate, inspectors say, is $150 a month, sometimes paid in gift cards for a grocery store). Often, there were no patients at all. Frequently, there wasn't even an actual physical clinic, the OIG says; though providers were required to have a brick-and-mortar space, inspectors would visit addresses only to find that providers were "phantom clinics" — rooms the size of broom closets with only a few chairs and a gumball machine.

The OIG report states that in combating fraud, the government and its contractors have "used multiple approaches but none has proven successful over time." Medicare has stopped paying for certain drugs with high profit margins, for example, but the bad providers simply switch over and start billing for a different drug. Medicare can revoke provider numbers, but it has to give the provider 30 days' notice — which is plenty of time for fraudulent providers to keep billing. And even if providers get their number revoked, they can apply for other ones. The report mentions one guy who had 19 numbers revoked — and just kept on billing on his other ten."

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